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Before the “Fogarty” era, direct incision was the only way to save the patient with atrial thrombi. After Dr. Fogarty invented the unique catheter, we can retrieve it with minimum incision. But it really needs “incision”. We invented a novel fully percutaneous thrombectomy technique and successfully treated four patients with acute limb ischemia using this technique.
We used OPTIMO (Tokai medical, Aichi, JAPAN) as an occlusion guiding catheter (OGC). This OGC is 9Fr with occlusion balloon. With specific inner dilator, we can insert it without sheath. Outer diameter is equal to 7Fr sheath and inner lumen is 8Fr guiding catheter. After insertion of this OGC directly, we advanced Over-the-wire Fogarty Thru-Lumen Embolectomy Catheter (Edwards Lifesciences, Irvine, CA, USA) through an atrial thrombi. Pulling back the Fogarty catheter into the OGC, we can retrieve the whole thrombi.
We could successfuly remove the whole thrombi avoiding distal embolism in the four patients with acute limb ischemia using this novel technique; (1) iliac artery (Figure), (2) superficial femoral artery(SFA), (3) brachial artery and (4) in-stent thrombi in SFA.
ALI is still major and unsolved problem in EVT fields. Of course cut down and retrieve thrombi is the golden standard. Now, there are many challenging attempts to complete the procedure without incision; thrombolysis and combination of mechanical break and aspiration with specific devices.The advantage of our method is free from anticoagulant and less invasive. This can be one of the equipment for acute arterial thrombi.
ENDOVASCULAR: Peripheral Vascular Disease and Intervention